If the genes fit.

Forget FLOT (and radiation), this phase 2 trial established safety and efficacy of peri-op “pharmacogenomically-dosed” FOLFIRINOX for locally-advanced esophageal and gastric cancers. Say what kind of FOLFIRINOX? Apparently there is a gene UGT1A1 that encodes an enzyme important for metabolizing irinotecan. There is normal (7/7), intermediate (6/7), and slow (6/6) metabolizing genotypes. And they can receive normal, low and lowest dosing of irinotecan accordingly. That’s what happened here where 33/36 patients (92%) achieved an R0 resection and 9/36 (25%) had <10% residual tumor at time or surgery. TBL: Genotype-dosed peri-operative FOLFIRINOX shows promising efficacy for locally-advanced gastro-esophageal cancer while maximizing safety. | Catenacci, JAMA Oncol 2020